Comparison of EUS-guided conventional smear and liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis

Abstract

Background and study aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) has limitations of inadequate sampling and false-negative results for malignancy. It has been performed using conventional smear (CS) cytology with rapid on-site evaluation (ROSE) with reasonable diagnostic accuracy. An alternative to ROSE is liquid-based cytology (LBC). Commonly used LBC techniques include precipitation-based (SurePath™) and filtration-based (ThinPrep®, CellPrep®). Data regarding the diagnostic efficacy of LBC compared with CS are limited. Methods Multiple databases were searched through March 2020 to identify studies reporting diagnostic yield of EUS-guided CS and LBC in pancreatic lesions. Pooled diagnostic odds and rates of performance for the cytologic diagnoses of benign, suspicious, and malignant lesions were calculated. Diagnostic efficacy was evaluated by pooled rates of accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results Nine studies with a total of 1308 patients were included in our final analysis. Pooled diagnostic odds of CS cytology were 1.69 (CI 1.02–2.79) and 0.39 (CI 0.19–0.8) for malignant lesions when compared to filtration-based and precipitation-based LBC techniques, respectively. For CS, precipitation-based and filtration-based LBC, pooled diagnostic accuracy was 79.7 %, 85.2 %, 77.3 %, sensitivity was 79.2 %, 83.6 %, 68.3 %, and specificity was 99.4 %, 99.5 %, 99.5 %, respectively. Conclusions The precipitation-based LBC technique (SurePath™) had superior diagnostic odds for malignant pancreatic lesions compared with CS cytology in the absence of ROSE. It showed superior accuracy and sensitivity, but comparable specificity and PPV. Diagnostic odds of CS cytology in the absence of ROSE were superior to the filtration-based LBC technique (ThinPrep®, Cellprep®) for diagnosing malignant pancreatic lesions.

Endosonographers performing on-site evaluation of solid pancreatic specimens for EUS-guided biopsy

“…The main reason for false-negative results was that when using conventional smear cytology, only segmental liquid sample was obtained for smear specimens, which might not fully represent all pathological changes, leading to the misdiagnosis of some neoplastic lesions. According to a recent meta-analysis by Saurabh et al .,[ 24 25 ] the overall diagnostic accuracy, sensitivity, and specificity of EUS-guided smear cytology in pancreatic lesions was 79.7%, 79.2%, and 99.4%, which was close to the results of this study, meaning that the diagnostic efficiency of Diff-Quik-stained specimens in this study had reached the average level of smear cytology. Notably, touch imprint cytology (TIC) is a cytological technique often applied in the frozen section of intraoperative pathology to determine whether it is benign or malignant.…”

A prospective randomized noninferiority trial comparing conventional smears and SurePathTM liquid-based cytology in endoscopic ultrasound-guided sampling of esophageal, gastric, and duodenal lesions

“…[10,15] (LeBlanc, ThinPrep 75.5% vs CS 95.7%; de Luna R., ThinPrep 67% vs CS 84%) However, 2 previous studies using ThinPrep LBC and a recent meta-analysis of pancreatic lesions reported that ThinPrep LBC underperformed CSs. [16] In ThinPrep LBC, sample loss occurred during the collection process in up to 38% of the samples, so the diagnostic rate was lower than that of SurePath. [17]…”

Endoscopic ultrasound‐guided fine‐needle biopsy histology with a 22‐gauge Franseen needle and fine‐needle aspiration liquid‐based cytology with a conventional 25‐gauge needle provide comparable diagnostic accuracy in solid pancreatic lesions

“…Conducting a cytologic assessment on samples acquired through FNA with a conventional 25‐gauge needle provides higher diagnostic accuracy than a histologic assessment 6,17,18 . Compared to CS cytology without ROSE, the precipitation‐based LBC technique (SurePath; Becton, Dickinson and Company) has attracted attention because of its sensitivity for malignant pancreatic lesions 19 . We performed precipitation‐based LBC for samples acquired through FNA with a conventional 25‐gauge needle to increase the diagnostic accuracy of our technique.…”

“…Previous studies have also proposed that 25G‐FNA needles were superior to 22G‐FNA needles in terms of the overall diagnostic accuracy of cytologic findings 6,17,18 . While cytologic evaluation has traditionally been performed with conventional smear cytology, whereas recent studies have proposed that precipitation‐based and liquid‐based cytology (LBC) (SurePath, Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA) provides superior diagnostic detail in the absence of rapid on‐site evaluation (ROSE) 19 . We compared the diagnostic ability of EUS‐FNB histological examination using 22G‐FNB‐H and EUS‐FNA‐ liquid‐based cytological examination using a conventional 25G‐FNA‐LBC in solid pancreatic lesions.…”